The development of long-lasting hyaluronic acid injectables (such as Juvederm, Voluma, and Restylane) and the introduction of cannula injection techniques has been the most significant advancement in facial rejuvenation in the last decade. In the appropriate patient, we can achieve long lasting total facial rejuvenation.
Where are injectables most effective?
As the manufacturers have developed a broader range of hyaluronic acid products such as Voluma and Restylane Lyft we have been able to accomplish dramatic nonsurgical rejuvenation. Typically a thinner face will have more options for injection. Areas we routinely inject are: the temples, upper orbital rim, under eye (lower orbital rim), outer and central cheek, buccal hollow, naso labial fold (smile lines), marionette lines, prejowl sulcus, jawline and lips.
Permanent or temporary fillers?
Our 20 years’ experience of injecting many different materials (hyaluronic acid since 2005) in thousands of patients for facial rejuvenation has resulted in our current thinking that the hyaluronic acid products (juvederm, voluma, restylane) provide the greatest benefit to risk profile. These materials are significantly longer lasting than believed, often providing results for years when properly injected (remember the advertised duration is based on the companies FDA submission and not actual duration). On the safety side, HA are the only injectable material that can be dissolved which is easily accomplished in a few minutes by injecting a chemical, hyaluronidase, into the filler. This gives peace of mind that if the result is unsatisfactory it can be reversed but more importantly it removes the material to allow more effective treatment of any nodules or infection.
Radiesse (calcium hydroxy apetite )and Bellafil (poly methylmethacrylate) are composed of beads of non resorbable material. We have two main concerns with these materials. The first is the development (which we have experienced) even years after injection of developing a granuloma (hard nodule) or infection. The second is that we have seen areas that these products are injected into become noticeably irregular years after injection as the surrounding soft tissue thins out with age. Additionally these products create a lot of scarring that is difficult to dissect through during facelift surgery.
What is the best hyaluronic acid?
The best hyaluronic acid depends on where it is being injected. Some products like juvederm are very soft and absorb a large amount of water making them particularly useful in lips and skin lines. Others like Voluma and Restylane Lyft are firm and absorb less water and are particularly good for midface and jawline volume.
What is the role of cannulas? What is Cannula injecting?
A cannula is a very fine flexible tube with a blunt tip that is used to inject fillers. A small needle hole is made in the skin to insert the cannula. Every injection site in the face can be treated with a cannula.
There are many benefits to cannula injection. There is typically minimal to no bruising. The procedures are much less painful. Cannulas virtually eliminate the worst potential complications of fillers.
Why do celebrity’s end up looking so weird?
We only notice the bad, many celebrities and everyday people have injectable treatments and they look great. Many of the strange appearances result from trying to accomplish too much with injectables. There are times when surgery is necessary to achieve a natural result and it is the responsibility of the injector to let a patient know the limitations of any procedure. The spectrum of injectors ranges from highly experienced and well trained surgeons to non-medical injectors illegally treating patients in hotel rooms. The combination of vast experience as well as an understanding of facial aesthetics that is unparalleled sets us apart from other injectors.